title: Factors associated with hand hygiene compliance at a tertiary care teaching hospital.
abstract: OBJECTIVE
  To identify factors associated with hand hygiene compliance during a multiyear period of intervention.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  A 719-bed tertiary care teaching hospital.
  
  
  METHODS
  Nursing, physician, technical, and support staff.
  
  
  METHODS
  Light-duty staff performed hand hygiene observations during the period July 2008-December 2012. Infection control implemented hospital-wide hand hygiene initiatives, including education modules; posters and table tents; feedback to units, medical directors and the executive board; and an increased number of automated alcohol hand hygiene product dispensers.
  
  
  RESULTS
  There were 161,526 unique observations; overall compliance was 83%. Significant differences in compliance were observed between physician staff (78%) and support staff (69%) compared with nursing staff (84%). Pediatric units (84%) and intensive care units (84%) had higher compliance than did medical (82%) and surgical units (81%). These findings persisted in the controlled multivariate model for noncompliance. Additional factors found to be significant in the model included greater compliance when healthcare workers were leaving patient rooms, when the patient was under contact precautions, and during the evening shift. The overall rate of compliance increased from 60% in the first year of observation to a peak of 96% in the fourth year, and it decreased to 89% in the final year, with significant improvements occurring in each of the 4 professional categories.
  
  
  CONCLUSIONS
  A multipronged hand hygiene initiative is effective in increasing compliance rates among all categories of hospital workers. We identified a variety of factors associated with increased compliance. Additionally, we note the importance of continuous interventions in maintaining high compliance rates.
authors.affiliation: Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Kowitt
authors.forename: Julie
authors.initials: J
authors.lastname: Jefferson
authors.forename: Leonard A
authors.initials: LA
authors.lastname: Mermel
mesh_terms: D019983:Guideline Adherence; D063373:Hand Hygiene / Q000592:standards*; D006757:Hospital Units / Q000706:statistics & numerical data; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D017053:Infection Control / Q000592:standards; D009726:Nurses / Q000706:statistics & numerical data; D010356:Patient Isolation; D010564:Personnel, Hospital / Q000193:education / Q000706:statistics & numerical data; D010820:Physicians / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D062606:Tertiary Care Centers; D013997:Time Factors